Abstract
Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap. To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves outcomes for college women with EDs compared with referral to usual care. This cluster randomized trial was conducted from 2014 to 2018 at 27 US universities. Women with binge-purge EDs (with both threshold and subthreshold presentations) were recruited from enrolled universities. The 690 participants were followed up for up to 2 years after the intervention. Data analysis was performed from February to September 2019. Universities were randomized to the intervention, Student Bodies-Eating Disorders, a digital CBT-guided self-help program, or to referral to usual care. The main outcome was change in overall ED psychopathology. Secondary outcomes were abstinence from binge eating and compensatory behaviors, as well as ED behavior frequencies, depression, anxiety, clinical impairment, academic impairment, and realized treatment access. A total of 690 women with EDs (mean [SD] age, 22.12 [4.85] years; 414 [60.0%] White; 120 [17.4%] Hispanic; 512 [74.2%] undergraduates) were included in the analyses. For ED psychopathology, there was a significantly greater reduction in the intervention group compared with the control group at the postintervention assessment (β [SE], -0.44 [0.10]; d = -0.40; t1387 = -4.23; P < .001), as well as over the follow-up period (β [SE], -0.39 [0.12]; d = -0.35; t1387 = -3.30; P < .001). There was not a significant difference in abstinence from any ED behaviors at the postintervention assessment (odds ratio, 1.48; 95% CI, 0.48-4.62; P = .50) or at follow-up (odds ratio, 1.51; 95% CI, 0.63-3.58; P = .36). Compared with the control group, the intervention group had significantly greater reductions in binge eating (rate ratio, 0.82; 95% CI, 0.70-0.96; P = .02), compensatory behaviors (rate ratio, 0.68; 95% CI, 0.54-0.86; P < .001), depression (β [SE], -1.34 [0.53]; d = -0.22; t1387 = -2.52; P = .01), and clinical impairment (β [SE], -2.33 [0.94]; d = -0.21; t1387 = -2.49; P = .01) at the postintervention assessment, with these gains sustained through follow-up for all outcomes except binge eating. Groups did not differ in terms of academic impairment. The majority of intervention participants (318 of 385 participants [83%]) began the intervention, whereas only 28% of control participants (76 of 271 participants with follow-up data available) sought treatment for their ED (odds ratio, 12.36; 95% CI, 8.73-17.51; P < .001). In this cluster randomized clinical trial comparing a coached, digital CBT intervention with referral to usual care, the intervention was effective in reducing ED psychopathology, compensatory behaviors, depression, and clinical impairment through long-term follow-up, as well as realizing treatment access. No difference was found between the intervention and control groups for abstinence for all ED behaviors or academic impairment. Given its scalability, a coached, digital, CBT intervention for college women with EDs has the potential to address the wide treatment gap for these disorders. ClinicalTrials.gov Identifier: NCT02076464.
Highlights
Eating disorders (EDs) are severe psychiatric disorders associated with high morbidity and mortality, marked impairment, and poor quality of life.[1,2] College campuses are faced with an elevated prevalence of EDs, with 13.5% of US college women and 3.6% of US college men affected.[3]
Compared with the control group, the intervention group had significantly greater reductions in binge eating, compensatory behaviors, depression (β [SE], −1.34 [0.53]; d = −0.22; t1387 = −2.52; P = .01), and clinical impairment (β [SE], −2.33 [0.94]; d = −0.21; t1387 = −2.49; P = .01) at the postintervention assessment, with these gains sustained through follow-up for all outcomes except binge eating
Digital Cognitive Behavior Therapy–Guided Intervention for Eating Disorders in College Women. In this cluster randomized clinical trial comparing a coached, digital cognitive behavior therapy (CBT) intervention with referral to usual care, the intervention was effective in reducing ED psychopathology, compensatory behaviors, depression, and clinical impairment through long-term follow-up, as well as realizing treatment access
Summary
Eating disorders (EDs) are severe psychiatric disorders associated with high morbidity and mortality, marked impairment, and poor quality of life.[1,2] College campuses are faced with an elevated prevalence of EDs, with 13.5% of US college women and 3.6% of US college men affected.[3]. Inadequacies in care delivery are associated with prolonged illness, poorer prognosis, and greater relapse, highlighting the need for improved modalities for screening and intervention, in the at-risk group of college students.[6,7] Current treatment delivery efforts for EDs on college campuses are hindered by factors such as limited counseling center capacity and access to evidence-based treatments.[6,7,8,9] College students report additional barriers, including lack of time and stigma.[10] Digital technologies, highlighted as the future of psychiatry,[11] have the potential to improve mental health care on college campuses by overcoming barriers.[12] online screens have been developed that can identify individuals with a possible ED, who can be offered services.[13,14] to date, there have been no large-scale studies in college populations that have evaluated the effects of a digital intervention for treating EDs, linked with an online screen
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
